Family Planning

Question 1

What are the goals of family planning

Answer 1

Goals of Family Planning
●Every pregnancy will be both
●Wanted
●Planned and prepared for
●If we achieve these goals, we will
●Reduce
●Number of abortions, maternal mortality and poor fetal outcome
●Number of HIV infected babies
●Population explosion
●Increase
●Maternal and infant health

Question 2

What is family planning
How is it achieved ?
What does it involve?
What things can play a role in family planning decisions

Answer 2

Family planning is “the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility.“

Family planning may involve consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which a person wishes to have them.
●Things that may play a role on family planning decisions (highly variable from person to person): marital situation, career or work considerations, financial situations.
●If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

Question 3

State four issues regarding use of contraceptives
What topics must you cover during the first visit?

Answer 3

Issues regarding choice
●Age
●Efficacy required
●Ease of use
●Smoking status

First Visit
Topics to cover for each method
●Efficacy
●Individual suitability
●Absolute contra-indications
●Side effects
●Adverse reactions
Advantages other than contraception
●Mode of use
●Onset of action
●Follow-up arrangements
●Timing of return to fertility
●Protection against sexually transmitted disease

Question 4

What is important in the history of someone needing contraceptives

Answer 4

History
●Existing medical problems
●Regular medication
●Family history
●Menstrual history
●Obstetric history
●Previous contraceptive use

Question 5

State four methods of contraceptives
State four hormonal methods

Answer 5

Methods of Contraception
●Hormonal Contraception；
●Intrauterine contraceptive device (IUD)
●Emergency Contraception；
●Natural family planning；
●Male Contraception；

Hormonal methods
●Oral contraceptives
●Pills
●Depo-Provera
●Norplant
●Vaginal ring

Question 6

What are the types of oral hormonal contraceptives
What’s the mechanism of action for these oral hormonal contraceptives

Answer 6

ORAL HORMONAL CONTRACEPTIVES
synthetic steroids
●Combined oestrogen/progestogen
●Progestogen only

Mechanism of action
Consistently inhibit the midcycle gonadotropin surge , prevent ovulation.
●Alter the cervical mucus
●Alter motility of the muscle of the uterus and oviducts
●Alter the endometrium
●Alter ovarian responsiveness to gonadotropin stimulation

Question 7

State six types of frequently used oral hormonal contraceptives

Answer 7

Types of Frequently Used Contraceptives
●Short-term Contraceptives：Marvelon；
●Long-term Contraceptives：Oral Contraceptives，
Contraceptive Injections ；
●Vacation Pills；
●Norplant;
●Slow-released Contraceptive Vaginal Ring (CVR)
●Micro-sphere and micro-cyst Contraceptive Injections ；
●Transdermal Patch；

Question 8

What is the indication (state one) and the contraindications (state five)for oral hormonal contraceptives

Answer 8

O C Contraindications
●Thrombophlebitis or thromboembolic disorders
●Past history of DVT or thromboembolic disorders
●Cerebral vascular disease or coronary artery disease
●Known or suspected carcinoma of the breast
●Carcinoma of the endometrium
●Undiagnosed abnormal genital bleeding
●Jaundice
●Hepatic adenomas or carcinomas
●Known or suspected pregnancy
●Smoker over age 35

Indications ：
healthy women of reproductive age；

Question 9

What are the non contraceptive benefits of OC(state seven)
(What does non contraceptive mean?
: not used for or relating to contraception utilizing birth control for noncontraceptive purposes)

Answer 9

OC Noncontraceptive Benefits
1. Reduced risk of ovarian and endometrial cancer
2. Menstrual benefits: reduction in menorrhagia and dysmenorrhea, iron-deficiency anemia, Regulates the menstrual cycle
3.Improvements in acne, hirsutism and symptomatic endometriosis.

4.Relieves perimenopausal symptoms
●5.Treatment of dysfunctional uterine bleeding
●6. Protection against ectopic pregnancy
●7. Reduced incidence and severity of PID
●8. Maintenance of bone density

Question 10

What are the disadvantages or side effects of OC

OC Health Risks-breast Cancer
●No significant increased risk among current or former users
●Small increased risk of breast cancer diagnosis
●Link to earlier diagnosis of breast cancer
OC Health Risks-cervical Cancer
●Numerous studies have linked OC use and cervical neoplasia
●Findings are difficult to interpret

Answer 10

ORAL HORMONAL CONTRACEPTIVES
●Disadvantages And Side Effects
1. thromboembolic disease
including pulmonary embolism and cerebral thrombosis
venous thromboembolism,coronary thrombosis
2. change the lipid/lipoprotein profile in an adverse direction
3.hypertension, cholelithiasis, and benign liver tumors

●4.Intermenstrual bleeding including breakthrough bleeding and spotting 10%-20%
●5.amenorrhea: infrequent
●6.Nausea :10%
●7.headaches :less frequent
●8.weight gain

Question 11

Under Pills,what’s the formulation of Progestin only pills
Who are the candidates for this kind of pills?
State two side effects

Answer 11

Progestin-Only Pills
●Formulation:
●Contains norethindrone or nogestrel
●28 days of active hormones

●Candidates:
●Women who cannot or will not take estrogen ：those having a documented hypersensitivity to estrogens
●Postpartum and lactating women

The Minipill
Or Progestin-Only Pill
●pregnancy rate of about 2-7 per 100 woman years
●side effects
1.irregularity of the ovulatory cycle
2.ectopic pregnancies

Question 12

State three long acting contraceptives
Under DMPA ,what are the side effects and the health benefits
List four for each

Answer 12

Long-Acting Contraceptives
Currently available:
●Injectable DMPA (Depo-Provera)
●Copper IUD (Paragard)
●Progestin IUD (Mirena )

Injectable hormones:
progestin-only
DMPA (depo-Provera)
150mg every 90 days
DMPA Side Effects
●Menstrual changes
●Delayed return of fertility
●Alopecia
●Reduced libido
●Weight gain?
●Depression?

DMPA Health Risks & Benefits
●Loss of bone mineral density?
●Lowered HDL(high density lipoprotein) level
●Protection against endometrial cancer, no impact on risk of other types of cancer
●Reduces PMS （ premenstrual syndrome, iron-deficiency anemia, risks of PID （pelvic inflammatory disease,,ectopic pregnancy

Question 13

Under implantation,state the dosage for Norplant
What is Norplant?

Answer 13

Norplant
●2 sticks LNG[=levonorgestrel] 70mg /one
●progestin only

Norplant
an implantable contraceptive that releases levonorgestrel a system that contains 36 mg of levonorgestrel in each of 6 Silasticrods
●Efficacy is high
first-year pregnancy rates are only 0.2% cumulative 5-year rates of 3.9%

Question 14

State four side effects of implants and two benefits

Answer 14

Irregular bleeding
●Amenorrhea
●Headache
●Hair loss
●Weight gain
●Functional ovarian cysts

Implant Benefits
●Improvement of dysmenorrhea
● Improvement of PMS

Question 15

What is vaginal ring
State six non hormonal contraceptives

Answer 15

vaginal ring
●plastic device, measuring approximately 2 inches in diameter.
●releases 120 μg of the etonogestrel (the major metabolite of desogestrel and 15 μg of ethinyl estradiol daily)

NONHORMONAL CONTRACEPTION
●Coitus interruptus
●Barrier Contraceptives
Male condom
Female condom
Diaphragms
Cervical cap
Spermicidal preparations/ Spermicides
●Natural family planning

Question 16

What is a male condom
What are the advantages of this?
State three

Answer 16

MALE CONDOM
●A male condom is a thin sheath made of latex or other materials

MALE CONDOM
●advantages
1. highly effective
2.inexpensive
3. protection against pregnancy & sexually transmitted diseases (STDs).
●Latex and polyurethane condoms also provide limited protection against HPV that can cause genital warts
●HSV that can cause genital herpes
●Hepatitis-B virus

Question 17

How do female condoms work
State two advantages

Answer 17

advantage
1. being under the control of the female partner
2. offering some protection against STDs.

Has two flexible rings
●
●The inner ring at the closed end of the condom eases insertion into the vagina, covering the cervix and holding the condom in place
●
●The outer ring , The larger, open ring stays outside the vagina, covering part of the perineum and labia during intercourse.
●

Question 18

Explain the barrier method in using diaphragms (know the positions for insertion and removal)
What is a cervical cap
What are the types

Answer 18

The diaphragm fits over the cervical opening thereby preventing sperm from entering the uterus
The cervical cap also fits over the cervix thereby preventing sperm from entering the uterus

The Cervical Cap
●A cervical cap is a soft, deep rubber cup
(like a thimble) with a firm, round rim that fits snugly over the cervix.

Cavity rim cap
Vimule cap
Dumas cap

Question 19

State four forms of spermicides
Mirena is the most common long acting contraceptive
What do spermicides contain?
Spermicides don’t protect you from what?

Answer 19

he form of Spermicides
●Creams
● Films
● Foams
● Jellies
●Sponges
●suppositories

Delfen is the most common spermicidal

spermicides
●The majority of spermicides contain nonoxynol-9
●when used alone, failure rate about 15% per year.
●not effective in preventing
cervical gonorrhea
chlamydia
HIV infection

Question 20

Explain the natural family planning method
State the three methods

Answer 20

NATURAL FAMILY PLANNING METHOD
●Also called periodic abstinence or fertility awareness or rhythm method
●requires that coitus be avoided during the time of the cycle when a fertilizable ovum and motile sperm could meet in the oviduct.

METHOD
●1. Calendar (“rhythm”) method
●2. Basal body temperature (BBT) method
●3. Cervical mucus (ovulation or Billings) method

Question 21

Explain the rhythm method
What is the fertility cycle

Explain basal body temperature method

Answer 21

Rhythm Method (“safe Period”)
●24 hours are allowed for ovum survival
●3 days are allowed for the sperms
●Coitus must be avoided from the 9th to the 16th day(cuz there’s proliferation and ovulation and estrogen is increased)

BBT
there is a slight drop in temperature 24-36 hours after ovulation. The temperature then rises abruptly about 0.３ -0.4℃ (0.5-0.7°F) and remains at this plateau for the remainder of the cycle.

the fertile period
at least 2 days before ovulation to no less than 2 days after ovulation

The third day after the onset of elevated temperature is considered to be the end of the fertile period

Question 22

Explain the Billings method
State three types of intra uterine devices
What is the mechanism of action for copper bearing ,is it hormonal or simply mechanical or both?

Answer 22

The cervical mucus (Billings) method
●several days before and until just after ovulation, the mucus becomes thin and watery
●at other times
the mucus is thick and opaque

Intra Uterine Devices
●Inert
●Copper bearing-the Copper TCu380A (Paragard)
●Progestogen releasing-a levonorgestrel-releasing system (Mirena) (I think)
● Mirena can be used for up to 5 years

Question 23

State four complications and four disadvantages of inserting IUDs

Answer 23

Complications Of Insertion
●1.moderate discomfort or pain
2.syncopal reactions
3.Partial or complete perforation of the uterus (rare)
4. uttering cramps

Disadvantages And Side Effects
●1. Pregnancy
●2. Expulsion rates :
Copper T (Paragard) = 6%
Progesterone-releasing IUDs = 3~8%
●3. Bleeding or Pain
●4. Pelvic Infection: pelvic inflammatory disease or salpingitis .
higher risk :
multiple sexual partners
prior STDs

Question 24

State ten contraindications of IUDs
Who are the suitable candidates for IUD

Answer 24

Contraindications
To The Use Of IUDs
●Absolute contraindications
1.current pregnancy
2. undiagnosed abnormal vaginal bleeding;
3. acute cervical, uterine, or salpingeal infection;
4. past salpingitis;
5. suspected gynecologic malignancy

Relative contraindications

●1.nulliparity or high priority attached to future childbearing;
2. prior ectopic pregnancy;
3.history of STDs; multiple sexual partners;
4.moderate or severe dysmenorrheal;
5.congenital anomalies of the uterus or the abnormalities such as leiomyomas;
6. iron deficiency anemia (for the copper IUD);
7.valvular heart disease
8.frequent expulsions or problems with prior IUD use.

Suitable Candidates For An IUD
parous women in a mutually monogamous relationship who do not have a current or prior history of STDs or salpingitis

Question 25

Explain emergency contraceptives
What are the methods.?

Answer 25

POSTCOITAL OR
EMERGENCY CONTRACEPTION
●Is a therapy used to prevent unwanted pregnancy after unprotected intercourse or after a failure of a barrier method.

methods
●1.Yuzpe method
It consists of two tablets, each containing ethinyl estradiol 0. 05 mg and 0. 5 mg norgestrel
ingested 12 hours apart for a total of 4 tablets. initiated within 72 hours of intercourse
the effectiveness is about 74%

2.Progestin-only post-coital contraception
Levonorgestrel
3.IUD 120h
4.Contraceptive pill 72h
5.mifepristone

Question 26

State two indications and contraindications of tubal sterilization operation
What are the methods of this operation

NEW METHODS: OrthoEvra “The Patch”

Answer 26

Tubal Sterilization Operation
●Permanent Method
●Indications:
1. Volunteer to sterilization without
contraindications；
2. Not suitable for pregnant women due to severe systemic disease；

Contraindications：
● 1. Temperature >37.50C twice within 24 hrs;
2. Can not bear operation owe to poor healthy situation；
3. Severe neurosis；
4. Acute vaginitis and pelvic infectious diseases.

Methods:
Abscise ，Ligation，Electric coagulation，Ring clamp

●Pathway:
Go through abdominal or by laparoscope;

Question 27

State two indications and four contraindications for induced abortion

Answer 27

Remedies for Failed Contraception
—Induced Abortion
●Indications:
Volunteer to terminate pregnancy without contraindications；
1. <10w , Surgical abortion by vacuum aspiration；
2. 10-14 w ,Surgical abortion by dilatation and extraction；

Contraindications
●1. Temperature >37.50C twice within 24 hrs;
2. Can not bear operation owe to poor
healthy；
3. Severe neurosis ；
4. Acute vaginitis and pelvic infectious diseases

Question 28

How is medical abortion done
And what is the optimal time ?
State four contraindications

Answer 28

Medical Abortion
●Mifepristone combined with Misoprostol；
Optimal time： <49 days, from the 1st day of LMP[=last menstrual period]

Medical Abortion
●Contraindications：
Disease of adrenal gland，
Diabetes mellitus，
Hematopathy，
Thrombotic disease,
Hypertension，
Glaucoma ；；

Question 29

What is the family planning method of choice for newly wedded couples
What is the family planning method for a couple with one child or more

What is the family planning method for breastfeeding mothers and women in climacteric

Answer 29

FAMILY PLANNING METHODS CHOICE
●The choice for newly wedded couple is male condom, female condom or spermicidal jelly.

●The couple with one child or more children should get a long term planning for contraception. The first choice for them is IUD. The other methods include male condom, oral hormonal contraceptives, Norplant and spermicidal jelly.

The women during breastfeeding: IUD or condom.

The women in climacteric (Climacteric is the period of life starting from the decline in ovarian activity until after the end of ovarian function. According to the definition, the period includes peri-menopause, menopause and post-menopause. ) could apply any methods for contraception except hormonal contraceptives.
●The condom is available for the people with STDs or HIV.

Question 30

What are the :
Mechanism of Oral contraceptives (OC).
● Advantages of Oral Hormonal Contraceptives
●Indications and contraindication of oral contraceptives
●Indications and Contraindications of Intrauterine device (IUD)；

Question 31

ASSIGNMENT
●A 17 year old G0 presents to clinic desiring information about contraceptive methods. She reports that she is sexually active with her boyfriend, using condoms occasionally, when she needs them. She has never used any other methods. She has had 2 lifetime partners. She became sexually active at age 15 and had sex with her first partner 3-4 times but didn’t use contraception. She has been sexually active with her current partner for the last year. She came today because she last had unprotected intercourse 3 days ago and is worried she might get pregnant. She has decided it’s time for a more reliable method of contraception.
●She has never had a Pap smear. She has history of well controlled seizure disorder and had appendicitis at age 11. She is taking Valproic Acid. She smokes one-half pack of cigarettes per day, drinks alcohol socially, and uses occasional marijuana. Her blood pressure is 100/60 and pulse is 68.

●Discussion Questions:

What history is required for recommending appropriate contraception?
2.What physical exam and studies are required for prescribing hormonal contraceptives?
3.What contraceptives should the patient be counseled about and what are the advantages and disadvantages of each method?
4.When/how to start the contraceptive method?

Comment on the essential features required for an ideal contraceptive.

2. What are the Assisted Reproductive Techniques practised to help infertile couples? Describe any three techniques.
3. Discuss the mode of action and advantages/disadvantages of hormonal contraceptives
4. Briefly explain IVF and ET . What are the conditions in which these methods are advised?